Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC004722 | PA |
NPI | 1003163544 |
---|---|
Provider Name | Nicole C White |
First Address | Paoli, PA 19301-1236 |
Second Address | State College, PA 16801-7097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 14/08/2012 |